Flagellate Hyperpigmentation Following Treatment with Low-Dose Bleomycine: Report of two cases

Abstract

ÖZETBleomisin'in mukokutanöz yan etkileri, 100 U'den daha yüksek kümülatif dozları alan hastalarda yaygındır. Flagella benzeri hiperpigmentasyon bleomisin kullanımının neden olduğu, vakaların yaklaşık % 8-20'sinde görülen ilginç bir cilt reaksiyonudur. Mekanizması bilinmemektedir. Tanı karakteristik klinik görünüme dayanmaktadır. Hiperpigmente cilt lezyonlarının histolojik incelemesi, bazal keratinositlerde artmış melanin içeriğini ortaya koymaktadır. Hafif vakalar antihistaminiklere ve/veya sistemik steroide yanıt verir fakat birçok vakada ilacın kesilmesi gerekebilir. Biz rölatif olarak daha düşük (kümülatif dozlar 30 ve 38 U) dozlarla bleomisin kaynaklı flagella benzeri hiperpigmentasyonu olan 2 vaka sunuyoruz. Bleomisin kullanan hastalarda hiç de nadir olmayan bu komplikasyonu klinisyenler akılda bulundurmalıdırlar. Anahtar Kelimeler: Hiperpigmentasyon, Bileomisin, Cilt ABSTRACT Mucocutaneus side effects of bleomycin therapy are common in patients receiving cumulative doses greater than 100 U (100 mg). Flagellate hyperpigmentation is an interesting cutaneus reaction caused by bleomycin use, and is seen in about 8-20% of cases. The mechanism is unknown. Diagnosis is based on its characteristic clinical appearance. Histological examination of hyperpigmented skin lesions has demonstrated increased melanin content in basal keratinocytes. It has been suggested that mild cases may respond to antihistamines and ⁄ or systemic steroids, but in many cases discontinuation of the drug may be necessary. We present two patients (cumulative doses of 30 and 38 U) that developed bleomycin-induced flagellate hyperpigmentation with relatively low doses. Because the condition is not uncommon in patients who are using this drug, the clinician should be mindful of this complication.

Utilizing Cohesive Bandage to Prevent Adverse Effects of Bleomycin Sclerotherapy: A Case Report

“…Antihistamines and topical corticosteroids can be prescribed for the symptomatic treatment of pruritus and preventing microtrauma with scratching. 10,11…”

“…4,5 Specific treatment for flagellate dermatitis is currently unavailable. 10 When hyperpigmentation issues occur, they commonly resolve within 4 months, with cessation of bleomycin treatment; however, hyperpigmentation has been noted to be present up to 3 years after initial presentation. 4,5 Reintroduction of bleomycin can lead to recurrence of flagellate dermatitis.…”

“…Antihistamines and topical corticosteroids can be prescribed for the symptomatic treatment of pruritus and preventing microtrauma with scratching. 10,11 A cohesive or self-adhering bandage (eg, 3M Coban) is a type of bandage or wrap that adheres to itself but does not adhere well to other surfaces, like skin or hair. 3M Coban is commonly used as a wrap because it has a reliable hold and maintains compression without skin adhesion.…”